The chronicle of a lonely do-gooder family doctor who survived.

Tuesday, December 23, 2008

Busy busy

It's been more than a month since I blogged?!

Life has been pretty damn hectic since I dropped the bomb that I'm leaving my job. I mean, there was all the credentialing and paperwork for my new clinic at the 45th Street Clinic, but tying up loose ends at my current practice has been unreal. I started there eight years ago as just a temporary gig while Shiree finished her training (thinking we would probably end up moving where she could find a job) but things have snowballed. I currently have so many other (mostly uncompensated) responsibilities (medical director, electronic health record champion, running the Highline Urgent Care Clinic, chair of the Director's committee, quality committee) that handing these things off to other people has probably taken 40 hours a week by itself and underscores some of the reasons why I was feeling pretty overwhelmed and ineffective.

Then there's the patients. I'm touched, mostly, that so many of them have expressed so much regret that I'm leaving. Within 3 days of mailing the letter explaining my decision, the remaining 6 weeks of my schedule were completely booked. People have brought me presents and cards, and some cried. I ran into a few at the airport (where many of my patients work) and one lady, a TSA employee, ran up to me, grabbed me and gave me a big bear hug, totally freaking out my wife. Almost everyone said some form of "I'm so happy for you, and I'm really going to miss you" and they seemed pretty genuine about it. I probably will miss 75% of them but there's a sizeable minority whose lives are so chaotic, whose problems run so deep, that I have this enormous sense of relief at finally extracting myself from their misery. We did find a replacement doc who will start working the day after I leave. I sure hope he's comfortable with chronic pain, self-inflicted disease, and mental illness. How did I attract so many of these people?

Yes, I'm pretty exasperated with this place. I've been trying not to let it show, you know, not burn any bridges. My medical group is mostly filled with good people who serve a really difficult population within a health care system that is totally failing. But it's been hard.

I recently posted at Metafilter about the sorry state of primary care in the U.S. and I personally don't know how much longer I will hold out. I mean, I'm pretty excited about my new job and feel like it will definitely be a more effective organization, and I love practicing medicine, but I am skeptical I will last more than five more years practicing full time unless, by some miracle, there really is sweeping change in health care that is strongly favorable to primary care.

Which makes it really important that I pay off my loans in the next five years. I am currently writing applications for government loan repayment in exchange for a commitment to work with the poor and underserved. If any of that comes through, and with some frugal living, I will hopefully be rid of that ball and chain. And not having to make that $2100 payment every month for the next 20 years will really open up my career possibilities.

Although I am making contingency plans to get out of medicine, I wouldn't say that going to medical school was a mistake. I mean, I have skills that will render me a useful, employable member of society just about anywhere in the world. But things have gotten so bad in primary care that I'm simply not willing to shoulder the ever increasing burden of an inadequate system on my back indefinitely. And that realization has actually been very liberating.

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